Ga Flashcards
Define coeliac disease:
It is an autoimmune condition, associated with chronic inflammation of the small intestine
Dietary proteins known as gluten present in wheat, barley rye activates an abnormal immune response in intestinal mucosa, leading to malabsorption
Note: patients with celiac disease are at an increased risk of malabsorption of key nutrients (calcium, vitamin-d)
State the 3 symptoms associated with coeliac disease?
Diarrhea, abdominal pain and bloating
What dietary protein to avoid in patients with celiac disease:
Gluten
State the complications of celiac disease:
Weakening of the bones, osteoporosis
Iron deficiency anaemia
Vitamin b12 and folate deficiency
State the only effective treatment for coeliac disease?
Strict, life-long gluten-free diet
No drug treatment for celiac disease
What is the drug treatment of choice for the confirmed cases of refractory coeliac disease while awaiting specialist advice?
Prednisolone
unlike celiac disease, it is resistant or unresponsive to at least 12 months of treatment with a strict gluten-free diet
State the symptoms of diverticular disease?
Abdominal tenderness
and/or mild intermittent lower abdominal pain
with constipation, diarrhea and occasional rectal bleeds
Symptoms may overlap with other Gl complications
Diverticular disease is a condition where small pouches (diverticula) form in the lining of the digestive system, usually in the colon. These pouches can become inflamed or infected, leading to symptoms like abdominal pain, bloating, constipation, or diarrhea.
Diverticula can form due to weak spots in the colon wall, which can happen because of factors like a low-fiber diet, aging, or genetic predisposition. When there’s not enough fiber in the diet, the colon has to work harder to move stool, which can lead to increased pressure and the formation of diverticula.
What is the treatment of uncomplicated diverticulitis?
Low residue diet and bowel rest
Antibiotics are only given when patients are immunocompromised / signs of infection
A low residue diet is a way of eating that limits foods high in fiber and other indigestible materials. It’s designed to reduce the amount of undigested food passing through the gut, which can help alleviate symptoms like diarrhea, abdominal pain, and bloating.
State symptoms of diverticulosis:
Asymptomatic presence of diverticula (small pouches protruding from walls of large intestine)
Common in patients aged 40 and over
What surgery is required for patients with diffuse peritonitis?
Urgent sigmoid colectomy
State the two-side effects associated with sulfasalazine?
Blood disorders and lupus-like syndrome
State side effects of aminosalicylates:
Common = Cough, dizziness, fever, arthralgia, gastro discomfort, leucopoenia
(reduction of white blood cells = increased risk of infection), nausea, vomiting, skin reactions
Uncommon = alopecia, depression, myalgia, photosensitivity reaction,
thrombocytopenia
Very rare = agranulocytosis, cardiac inflammation, pancreatitis
State patient and carer advice for aminosalicylates:
Report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise
For sulfasalazine = some soft contact lens may be stained
State monitoring requirements for aminosalicylates:
Renal function should be monitored before starting an oral aminosalicylate, at 3 months of treatment and then annually during treatment
Full blood counts (including differential white cell count and platelet count) are necessarily initially, and at monthly intervals during the first 3 months
Liver function test should be performed at monthly intervals for first 3 months
What should be co-prescribed with methotrexate and why?
Folic acid, usually dosage once weekly, why because to avoid methotrexate toxicity
Define Crohn’s disease:
Chronic inflammatory bowel disease mainly affects the Gl tract, thickened area of GI wall with inflammation extending to all layers
State the symptoms of Crohn’s disease?
Abdominal pain, diarrhea, fever, weight loss, rectal bleeding, mouth ulcers, sore eyes, arthritis, fatigue
Crohn’s also a cause of secondary osteoporosis
State the non-drug treatment for Crohn’s disease:
Stop smoking and attention to nutrition
What is the monotherapy treatment of Crohn’s disease?
Prednisolone or methylprednisolone or IV hydrocortisone (to reduce remission / within first 12 months)
Budesonide (distal ileal, ileocecal or right sided colonic disease)
Sulfasalazine /mesalazine
What is the add-on treatment of Crohn’s disease?
Azathioprine or mercaptopurine
Methotrexate
In patients who are deficient to thiopurine methyltransferase what drug can be added to their Crohn’s treatment?
Methotrexate
Specialist treatment of Crohn’s disease?
Adalimumab or infliximab
Vedolizumab
Which two drugs can be used to treat diarrhea associated with Crohn’s disease without colitis?
Loperamide or codeine
Which drug is licensed for relief of diarrhea associated with Crohn’s disease?
Colestyramine
Which is the treatment of fistulating Crohn’s disease?
Metronidazole or/and ciprofloxacin
State some factual information regarding ulcerative colitis:
Common in 15-25 age range
It is life-long
Characterised by diffuse mucosal inflammation, relapse remitting pattern
What ages is ulcerative colitis most common in?
15-25
State the symptoms of ulcerative colitis:
Bloody diarrhea, urgent need to go to toilet, abdominal pain, > 6 weeks of faecal urgency, painful persistent urge to pass stool when rectum is empty
What are the complications associated with ulcerative colitis?
Secondary osteoporosis
Increased risk of colorectal cancer
Toxic megacolon
Venous thromboembolism
How should you manage symptoms of ulcerative colitis:
Diarrhoea - exclude any alternative cause
Do not prescribe loperamide unless advised by specialist as they do not usually reduce stool frequency and can increase the risk of toxic megacolon
Constipation - assess for bowel obstruction, if bowel obstruction is unlikely, ensure that diet includes adequate fluid and soluble fibre, and warn that soluble fibre sometimes increases bloating and distension. If symptoms persist despite dietary advice consider a bulk-forming laxative, such as ispaghula husk, methylcellulose, sterculia
Abdominal pain - persistent or recurrent abdominal pain is common in ulcerative colitis and may be caused by inflammatory exacerbations and poor disease control, obstruction, intestinal dilatation: Give paracetamol for pain relief and avoid NSAIDs
Why is it a risk of using loperamide for relief of diarrhea in patients with ulcerative colitis?
Increases risk of toxic megacolon
State some side effects for aminosalicylates?
Blood disorders, lupus-like syndrome, cough, gastrointestinal discomfort, leucopoenia, skin reactions
State one patient and carer advice for patients taking aminosalicylates?
To report any unexplained bruising, bleeding, purpura, fever, sore throat, malaise (blood disorders)
What is the monitoring requirement for aminosalicylates?
Monitor Renal function before treatment, 3 months and then annually
What do you monitor in breast-fed infants whose mother is taking balsalazide sodium?
Monitor for diarrhea in infant
State common side effects for Sulfasalazine?
Taste altered, urine abnormalities, insomnia, tinnitus, yellow discolouration of bodily fluids
State the monitoring requirements for sulfasalazine?
FBC, white cell count, platelet count initially, and at monthly intervals during first 3 months
LFTs at monthly intervals for first 3 months
What are the monitoring requirements for budesonide when used in autoimmune hepatitis?
LFTs should be done every 2 weeks for 1 month, and then at least every 3 months
What age is IBS common in?
20-30’s and is more common in women
What are the symptoms of IBS?
Abdominal pain, discomfort, diarrhea or constipation, passage of mucus and bloating
State counselling points for patients with IBS?
Increase physical activity, adults should aim to do 30 mins of moderate intensity of physical activity at-least 5 days of the week Advised to eat more regularly
Limit fresh fruit consumption to no more than 3 portions a day
Fluid intake mostly water should be increased to 8 cups a day
Sorbitol should be avoided in patients with diarrhoea
Probiotics can be used for at least 12 weeks
Encourage the patient to identify any associated stress, anxiety and/or depression
If there are predominant symptoms of constipation, advise patient to:
Try soluble fibre supplements for e.g.: ispaghula or food high in soluble fibre i.e., oats and linseed
If there are predominant symptoms of diarrhea and/or bloating advise the patient to:
Reduce intake of insoluble fibre, such as wholemeal or high fibre flour and breads
State the drug treatment for IBS?
Alverine citrate, mebeverine and peppermint oil all OTC medication that can be purchased OTC
Which drug laxative would you avoid in patients with IBS?
Lactulose due to it causing bloating
What can be prescribed if patients who have not responded to laxatives from different classes and who have had constipation for past 12 months for patients with IBS and is also licensed for moderate to severe IBS syndrome associated with constipation?
Linaclotide
